Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207LP2900X | Anesthesiology | Pain Medicine | 51991 | SOUTH CAROLINA | Yes |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | DO -2249 | WEST VIRGINIA | No |
| 3 | 207LP2900X | Anesthesiology | Pain Medicine | 0102203023 | VIRGINIA | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | P00999253 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE |
| 2 | P01146109 | OTHER | VIRGINIA | RAILROAD MEDICARE |
| 3 | 1831116375 | OTHER | WEST VIRGINIA | USDOL |
| 4 | 1831116375 | OTHER | WEST VIRGINIA | HEALTHPLAN |
| 5 | 3810024850 | MEDICAID | WEST VIRGINIA | |
| 6 | 1831116375 | OTHER | WEST VIRGINIA | UNITED HEALTHCARE |
| 7 | 519914 | MEDICAID | SOUTH CAROLINA | |
| 8 | 1831116375 | OTHER | WEST VIRGINIA | HEATLHNET/TRICARE |
| 9 | 1831116375 | OTHER | | CIGNA |
| 10 | 1831116375 | OTHER | WEST VIRGINIA | HIGHMARK OF WV |
| 11 | 1831116375 | OTHER | WEST VIRGINIA | SELECTNET |
| 12 | 1831116375 | OTHER | WEST VIRGINIA | COMPNET |
| 13 | 1831116375 | OTHER | WEST VIRGINIA | WELLS FARGO (PEIA) |
| 14 | 1831116375 | OTHER | WEST VIRGINIA | UMWA |
| 15 | 0011253000 | OTHER | WEST VIRGINIA | MEDICAID GROUP |
| 16 | 1831116375 | OTHER | WEST VIRGINIA | COVENTRY/CARELINK |
| 17 | 9296571 | OTHER | WEST VIRGINIA | MEDICARE GROUP |
| 18 | B596 | OTHER | VIRGINIA | MEDICARE GROUP |